I'm transgender and just got top surgery. Afraid the nipple is dying. What do they do once the nipple dies? (Photo)

Question

what procedure do they go about once it dies? and can you tell if it's dying

Jed H. Horowitz, MD, FACS · Answer

If it is still very soon into your #healing, your incisions and #nipples will go through a maturation #process. For the first few months they will be red and possibly raised and/or firm. As the scar matures, after 6-12 months, it becomes soft, pale, flat, and much less noticeable. You may experience numbness, tingling, burning, “crawling”, or other peculiar sensations around the surgical area. This is a result of the #healing of tiny fibers which are trapped in the incision site. These symptoms will disappear. Some people are prone to keloids, which is an abnormal scar that becomes prominent. If you or a blood relative has a tendency to keloid formation, please inform the doctor.
Bruising and #swelling are normal and usually increase slightly after the removal of any tape or foam. The bruising will decrease over 3-4 weeks, but may last as long as 6 weeks. The majority of the swelling will be gone within the first 3-4 weeks. However, it may take 6-9 weeks to disappear completely. Also, as you heal, the area may feel “lumpy” and irregular. This, too, decreases with time, and massaging these areas will help soften the scar tissue. The #compression garment helps reduce the swelling, and the longer it is worn, the more quickly you will #heal. It can also assist in the retraction of the skin. If you have any concerns about #healing, its best to ask questions of your surgeon or their nursing staff.

Anthony J. Wilson, MD · Answer

Thank you for your question. It is still early to determine how the nipple is going to finally heal. While it does appear as though there may be some delayed take often the top layer will come off and the underlying layer may be intact. Definitely give this more time. Keep the site covered and discuss with your PS if there are any other interventions they recommend.

Steven Turkeltaub, MD · Answer

From your photo and without a history it is difficult to discern as to whether of not the nipple is surviving. It may be that given time, this will look a bit more normal.You should contact your surgeon and discuss your concerns. In the unfortunate case where there is no residual nipple, the are techniques that can be employed to reconstruct the nipple.Steven Turkeltaub, MD

Josef Hadeed, MD, FACS · Answer

There are several options for nipple reconstruction including utilizing local tissues vs 3D tattooing.

Sheldon Lincenberg, MD · Answer

In the unfortunate event that the nipple graft does not take, a new nipple can be created after the skin heals fully. This can be done with a skin graft taken from a darker skin area of your body. Another choice is to request a nipple/areolar tattoo from an artist. I have seen some very realistic results that tattoo artists have created.

Babak Dadvand, MD · Answer

Hi ftm123,Thanks for the post. It depends on what technique was used and how far out from surgery you are. Free nipple grafts can take a longer period of time to declare themselves. If the nipple was left attached then blood supply issues may be noticed sooner. I would keep in close contact with your plastic surgeon. Sincerely,Dr. Dadvand

Ben J. Childers, MD, FACS · Answer

It takes some time for the nipple to declare and to know if you have lost the nipple.  I do free nipple graft techniques,  In this type of surgery the nipples areola complex is removed and replaced as a graft.  It takes a few days to see if the graft is taking.  In a technique where the nipple complex is retained in the surgery, on a pedicle of tissue, one can usually see a discoloration in the nipple.  Please consult with your surgeon and discuss your concerns.

Praful Ramineni, MD · Answer

It takes time for any tissue to "declare" itself as to how viable it is (if it's alive).  At this point it appears too early to make that determination and slow healing can be very common. If you had a free nipple graft, it is very possible that this is normal healing since the top layer of skin tends to peel off during the graft healing period.  At this point, I would recommend following up with your surgeon as recommended and follow his/her instructions.

I'm transgender and just got top surgery. Afraid the nipple is dying. What do they do once the nipple dies? (Photo)

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